title: Randomized trial of depression follow-up care by online messaging.
abstract: BACKGROUND
  Quality of antidepressant treatment remains disturbingly poor. Rates of medication adherence and follow-up contact are especially low in primary care, where most depression treatment begins. Telephone care management programs can address these gaps, but reliance on live contact makes such programs less available, less timely, and more expensive.
  
  
  OBJECTIVE
  Evaluate the feasibility, acceptability, and effectiveness of a depression care management program delivered by online messaging through an electronic medical record.
  
  
  METHODS
  Randomized controlled trial comparing usual primary care treatment to primary care supported by online care management
  
  
  METHODS
  Nine primary care clinics of an integrated health system in Washington state
  
  
  METHODS
  Two hundred and eight patients starting antidepressant treatment for depression.
  
  
  METHODS
  Three online care management contacts with a trained psychiatric nurse. Each contact included a structured assessment (severity of depression, medication adherence, side effects), algorithm-based feedback to the patient and treating physician, and as-needed facilitation of follow-up care. All communication occurred through secure, asynchronous messages within an electronic medical record.
  
  
  METHODS
  An online survey approximately five months after randomization assessed the primary outcome (depression severity according to the Symptom Checklist scale) and satisfaction with care, a secondary outcome. Additional secondary outcomes (antidepressant adherence and use of health services) were assessed using computerized medical records.
  
  
  RESULTS
  Patients offered the program had higher rates of antidepressant adherence (81% continued treatment more than 3 months vs. 61%, p = 0.001), lower Symptom Checklist depression scores after 5 months (0.95 vs. 1.17, p = 0.043), and greater satisfaction with depression treatment (53% "very satisfied" vs. 33%, p = 0.004).
  
  
  CONCLUSIONS
  The trial was conducted in one integrated health care system with a single care management nurse. Results apply only to patients using online messaging.
  
  
  CONCLUSIONS
  Our findings suggest that organized follow-up care for depression can be delivered effectively and efficiently through online messaging.
authors.affiliation: Group Health Research Institute, 1730 Minor Ave, #1600, Seattle, WA 98101, USA. simon.g@ghc.org
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Simon
authors.forename: James D
authors.initials: JD
authors.lastname: Ralston
authors.forename: James
authors.initials: J
authors.lastname: Savarino
authors.forename: Chester
authors.initials: C
authors.lastname: Pabiniak
authors.forename: Christine
authors.initials: C
authors.lastname: Wentzel
authors.forename: Belinda H
authors.initials: BH
authors.lastname: Operskalski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D003266:Continuity of Patient Care; D003695:Delivery of Health Care / Q000379:methods*; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D034742:Electronic Mail / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D009722:Nurse Practitioners / Q000706:statistics & numerical data; D009862:Online Systems; D011320:Primary Health Care / Q000379:methods*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents